Occult Grade 5 Splenic Injury in a Haemodynamically Stable Child Following Bicycle Handlebar Injury: A Case Report

Bicycle handlebar injuries are one of the most common mechanisms of major paediatric abdominal trauma, with the spleen being one of the most frequently affected solid organs. Grade 5 lesions represent the most severe and comparatively uncommon subtype. Despite the severity of these injuries, children often present with deceptively minimal abdominal signs and stable vital signs due to robust physiological compensatory mechanisms, making early diagnosis challenging. We describe a 13-year-old boy who sustained a grade 5 splenic injury following a bicycle handlebar impact. He presented as haemodynamically stable with left upper quadrant tenderness, no visible abdominal bruising, and minor facial abrasions. Imaging revealed a shattered spleen with haemoperitoneum and grade 5 splenic laceration. He underwent successful non-operative management and was discharged following an uncomplicated recovery. This case highlights the importance of maintaining a low threshold for imaging in paediatric trauma involving handlebar injuries. Abdominal tenderness in a conscious child following handlebar injury should prompt consideration of abdominopelvic CT, regardless of apparent clinical stability, in accordance with the Royal College of Radiologists Major Paediatric Trauma Radiology Guidance 2024, which recommends early imaging in such high-risk presentations.